The Ebola Outbreak

(CNN) -- A nurse contracts Ebola. An urgent care center in Boston shuts down when a sick man recently returned from Liberia walks in. Health care workers complain they haven't been properly trained to protect themselves against the deadly virus.
Public health experts are asking whether the U.S. Centers for Disease Control and Prevention is partly to blame.
Here are five things they say the CDC is getting wrong.

1. The CDC is telling possible Ebola patients to "call a doctor."
When passengers arrive in the United States from Liberia, Sierra Leone or Guinea, they're handed a flier instructing them to "call a doctor" if they feel ill.

Never mind how hard it is to get your doctor on the phone, but even if you could, it's quite possible she'd tell you to go to the nearest emergency room or urgent care center.

We saw how well that worked at Texas Health Presbyterian Hospital in Dallas. On September 25, the hospital sent a feverish Thomas Eric Duncan home even though he had told them he'd recently been to Liberia.
And we've seen how well that worked in Massachusetts, where an ill man recently returned from Liberia walked into an urgent care center, which then evacuated its other patients and closed for several hours.
One way to do it differently: Set up a toll free number for returning passengers that would reach a centralized office, which would then dispatch a local ambulance to get the patient to a hospital.
The hospital would be warned that a possible Ebola patient is on the way, and the patient would not be brought through the main emergency room.

That's the idea of Gavin Macgregor-Skinner, an assistant professor at Penn State's Department of Public Health Sciences.
"Do you really want someone with Ebola hopping on a bus to get to the hospital? No," he said. "And once they get there, do you want them sitting in the waiting room next to the kid with the broken arm? Again, no."
CDC Director Tom Frieden faces rising tide of criticism

2. The CDC director says any hospital can care for Ebola patients.
"Essentially any hospital in the country can safely take care of Ebola. You don't need a special hospital to do it," Dr. Thomas Frieden said Sunday at a press conference.

"I think it's very unfortunate that he keeps re-stating that," said Macgregor-Skinner, the global projects manager for the Elizabeth R. Griffin Foundation.


He said when it comes to handling Ebola, not all hospitals are created equally. As seen at Presbyterian, using protective gear can be tricky. Plus, it's a challenge to handle infectious waste from Ebola patients, such as hospital gowns contaminated with blood or vomit.

Dr. Michael Osterholm, an infectious disease epidemiologist at the University of Minnesota, said some hospitals have more experience with infectious diseases and consistently do drills in how to deal with biohazards.
"If you were a burn unit patient, wouldn't you want to go to a burn unit?" he said.
The CDC may already be moving in that direction.

Designating certain hospitals as Ebola treatment units "is something we're exploring further," said Tom Skinner, a spokesman for the agency.


3. The CDC didn't encourage the "buddy system" for doctors and nurses.
Under this system, a doctor or nurse who is about to do a procedure on an Ebola patient has a "buddy," another health care worker, who acts as a safety supervisor, monitoring the worker from the time he puts on the gear until the time he takes it off.
The "buddy system" has been effective in stopping other kinds of infections in hospitals.
Skinner said the CDC is considering recommending such a system to hospitals.

4. CDC didn't encourage doctors to develop Ebola treatment guidelines.
Taking care of Ebola patients is tricky, because certain procedures might put doctors and nurses in contact with the patient's infectious bodily fluids.
At Sunday's press conference, Frieden hinted that Presbyterian might have performed two measures -- inserting a breathing tube and giving kidney dialysis -- that were unlikely to help Duncan. He described them as a "desperate measure" to save his life.

"Both of those procedures may spread contaminated materials and are considered high-risk procedures," he said. "I'm not familiar with any prior patient with Ebola who has undergone either intubation or dialysis."
Osterholm said CDC should coordinate with medical groups to come up with treatment guidelines.
"We could have and should have done it a few months ago," he said.

5. The CDC put too much trust in protective gear.

Once Duncan was diagnosed, health authorities started making daily visits to 48 of his contacts.
But that didn't include several dozen workers at Presbyterian who took care of Duncan after he was diagnosed. They weren't followed because they were wearing protective gear when they had contact with Duncan. Instead, they monitored themselves.
Public health experts said that was a misstep, as the CDC should have realized that putting on and taking off protective gear is often done imperfectly and one of the workers might get an infection.
How did Dallas nurse contract Ebola?

"We have to recognize that our safety work tells us that breaches of protocol are the norm, not the exception in health care," said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. "We routinely break precautions."

Skinner said that in this case, self-monitoring worked, but that monitoring from health officials can be beneficial, too, and so health care workers who were involved in Duncan's care will now get daily visits from health authorities.

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(CNN) -- NBC medical correspondent Dr. Nancy Snyderman apologizes for violating quarantine. The husband of the Ebola-stricken Spanish nurse lashes out. A U.N. worker being treated for the disease in Germany dies. And the World Health Organization tweets that 8,914 Ebola cases and 4,447 deaths have been reported.

With multiple developments under way, here's what you need to know Tuesday to get caught up on the latest:

U.S. DEVELOPMENTS
An apology for breaking quarantine

NBC medical correspondent Dr. Nancy Snyderman has issued an apology after she reportedly violated the quarantine her team was placed in when their cameraman contracted Ebola. "As a health professional I know that we have no symptoms and pose no risk to the public, but I am deeply sorry for the concerns this episode caused," she said in a statement.

Cameraman says thank you
The NBC freelance cameraman who's recovering at the Nebraska Medical Center after contracting Ebola thanked everyone for their support in a Facebook post Monday. "There have been some dark and profoundly frightening moments in this ordeal," he wrote. "I won't ever know exactly when I slipped up and contracted the virus. I had been taking precautions but obviously they weren't enough."

Dallas nurse is 'clinically stable'

Officials are still trying to figure out how a Dallas nurse who cared for Ebola patient Thomas Eric Duncan was infected. Nina Pham, a recent nursing college graduate, got her certification less than two months earlier. On Monday, she got a blood transfusion from American Ebola survivor Kent Brantly and is "clinically stable."

Duncan's waste disposal blocked

A judge has granted a temporary restraining order blocking the disposal in a Louisiana hazardous waste landfill of incinerated waste from the Texas apartment where Ebola patient Duncan stayed. The company that incinerated the waste told CNN it had followed Centers for Disease Control and Prevention guidelines and had no plans to move the waste to Louisiana.

70 caregivers involved

About 70 staffers at Texas Health Presbyterian Hospital were involved in Duncan's care, The Associated Press reports. On Monday, CDC Director Tom Frieden said, "We do not today have a number of such exposed people or potentially exposed health care workers."

The blame game begins

The Agenda Project, a liberal advocacy group, has released an online ad that interlaces self-described "disturbing footages of the Ebola outbreak" with a mash-up of top Republicans -- including those tied up in crucial midterm contests and potential 2016 candidates -- saying the word "cut." The ad describes how the CDC saw its discretionary funding cut by $585 million from 2010 to 2014 and the National Institutes of Health has faced $446 million in cuts during the same period.

WEST AFRICA DEVELOPMENTS
WHO: 5,000 to 10,000 new cases weekly by December

The World Health Organization estimates that there will be 5,000 to 10,000 new Ebola cases weekly in West Africa by the first week of December, Dr. Bruce Aylward, WHO assistant director-general, told reporters Tuesday.

Officially, WHO has reported only 8,914 Ebola cases total in the entire months-long outbreak, but it has said that the total is under-reported. The mortality rate in this outbreak is about 70%, he said.

To start to decrease the rate of infection, the WHO says it hopes to isolate 70% of Ebola patients and have 70% of Ebola victim burials performed safely by December 1. Aylward said getting responders, facilities and plans in place to meet the goal will be very difficult. Missing the goal will mean that more people will die than should have and that even more resources will be needed because the infection rate will continue to climb, he said.

Chocolate companies join fight
Much of the production of the world's largest chocolate companies comes from West Africa, and the companies are worried the virus will disrupt production. Nestlé and Mars say they have already responded to a call from the World Cocoa Foundation, a nonprofit that helps small cocoa farmers. The group plans to disclose Wednesday how much it has raised. Others in the group include Hershey, Godiva, Ghirardelli, General Mills and Mondelez International.

IN OTHER COUNTRIES
Ebola patient dies in Germany
A U.N. worker being treated for Ebola in Germany has died. The Sudanese man had contracted Ebola while working in Liberia, the St. Georg clinic in Leipzig said.

Husband pens scathing letter
Teresa Romero Ramos, a nurse's assistant in Spain who contracted Ebola, is in critical condition and is having trouble breathing, authorities said. In a scathing letter, her husband said she received only 30 minutes of training in putting on protective gear and called for the resignation of Madrid's regional health minister. "Please explain to me how one puts on a protective suit, since unfortunately my wife doesn't have a master's degree in that," he wrote.

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12 September 2014 Last updated at 11:03 GMT

Cuba to send doctors to Ebola areas

By Smitha Mundasad
Health reporter, BBC News

Cuba is sending 165 health workers to help tackle the Ebola outbreak in West Africa, officials say.

Doctors, nurses and infection control specialists will travel to Sierra Leone in October and stay for six months.

The announcement comes as the World Health Organization says new cases in West Africa are increasing faster than the capacity to manage them.

More than 2,400 people have died from the virus in recent months and some 4,700 people have been infected.

The death toll remains highest in Liberia, Sierra Leone and Guinea.

World Health Organization (WHO) officials say the number of people affected is likely to be much greater than current estimates suggest.

In Liberia WHO experts say there is not a single bed left to treat patients with Ebola.

But the world football association, Fifa, says it is joining forces with the United Nations to turn the country's national stadium into a large-scale Ebola treatment unit.

Dr Margaret Chan, director of the WHO, said: "If we are going to go to war with Ebola we need the resources to fight.

"I am extremely grateful for the generosity of the Cuban government and these health professionals for doing their part to help us contain the worst Ebola outbreak ever known."

'Health diplomacy'

She added: "Cuba is world-famous for its ability to train outstanding doctors and nurses and for its generosity in helping fellow countries on the route to progress."

Through a global medical programme, doctors have been deployed to a range of countries, from Algeria to South Africa.

And many consider this medical help to be a central part of Cuba's international relations.

One of Cuba's most extensive efforts is an eye surgery programme in Venezuela where thousands of cataract operations have been performed.

Hundreds of Cuban medical workers were sent to Haiti during the earthquake in 2010.

The country also trains thousands of overseas medical students, many of whom return to their home nations to work.

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Daily Telegraph - West Africa could see up to 10,000 new Ebola cases a week within two months, the World Health Organisation has revealed in a grim new assessment of the crisis.
The death rate has also risen to 70 per cent for people who contract the lethal virus, according to figures released by the United Nations global health agency.

The WHO had previously estimated the death rate to be about 50 per cent per cent, already a high figure for a disease.
The agency increased its Ebola death toll tally to 4,447 people on Tuesday, nearly all of them in West Africa, from 8,914 cases. The true figure is thought to be significantly higher as many relatives have not reported infections and buried their dead because they fear that they will be put into isolation wards.

There have been about 1,000 new cases – confirmed, suspected and probable – per week during the last four weeks. Bruce Aylward, the WHO assistant director-general, said that if the world does not step up its response to the outbreak, "a lot more people will die" and there will be a huge need to deal with the spiralling numbers of cases
The startling new figures give fresh urgency to calls for greater resources to tackle the crisis. Speaking at a news conference in Johannesburg, the head of Medecins Sans Frontieres in South Africa, Sharon Ekambaram, lamented that medical workers in the region have received inadequate assistance from the international community.

"Where is WHO Africa? Where is the African Union?" said Dr Ekambaram who worked in Sierra Leone in August and September. "We've all heard their promises in the media, but have seen very little on the ground."

As the new assessment was made public, Mark Zuckerberg, the billionaire founder of Facebook, announced that he and his wife Priscilla Chan were donating $25 million to the Centre for Disease Control Foundation in the to help fight Ebola.
"We need to get Ebola under control in the near term so that it doesn't spread further ... that we end up fighting for decades at large scale, like HIV or polio," they said in a statement.

Dr Aylward said the 70 per cent death rate made Ebola "a high mortality disease" in any circumstance. The WHO target is to isolate 70 per cent of cases and provide treatment as soon as possible over the next two month in an effort to reverse outbreak, he said.

"It would be horrifically unethical to say that we're just going to isolate people," he said, noting that new strategies like handing out protective equipment to families and setting up very basic clinics was a priority.
Sierra Leone, Guinea and Liberia have suffered the brunt of the outbreak and Dr Aylward said WHO was very concerned about the continued spread of the disease in their densely-populated capital cities of Freetown, Conakry and Monrovia.
He said there was no evidence any countries were hiding Ebola cases but gave warning that countries bordering the affected area, including Ivory Coast, Mali and Guinea-Bissau, were at high risk of importing the disease.

"This is not a virus that's easy to suppress or hide," he said, noting there hasn't been a huge amount of international spreading so far. "I don't expect this virus to just go anywhere. There is exit screening in place and sick people won't be moving."

In Germany, an unnamed 56-year-old male UN medical worker infected with Ebola in Liberia died after four days in hospital in Leipzig. The man tested positive for the disease on Oct 6, prompting Liberia's UN peacekeeping mission to place 41 other staff members under "close medical observation."

The hospital's chief executive, Dr Iris Minde, said at the time there was no risk of infection for other people, since he was kept in a secure isolation ward specially equipped with negative pressure rooms that are hermetically sealed.

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Miragedriver said:

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THE PANDEMIC

Influenza Strikes
Throughout history, influenza viruses have mutated and caused pandemics or global epidemics. In 1890, an especially virulent influenza pandemic struck, killing many Americans. Those who survived that pandemic and lived to experience the 1918 pandemic tended to be less susceptible to the disease.
From Kansas to Europe and back again, wave after wave, the unfolding of the pandemic, mobilizing to fight influenza, the pandemic hits, protecting yourself, communication, fading of the pandemic.

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Voices of the Pandemic
March 1918 - January 1919. Communications through Public Health Reports, physicians, newspapers, letters, and telegrams.

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Fighting Influenza
During the mid to late nineteenth-century, physicians and scientists had begun to understand that diseases are caused by microorganisms. This was a radical departure from traditional medical theories which had held that diseases were caused by miasmas or an imbalance in the body’s humors.
How phyisicans understood influenza at the time, what happened to influenza patients in the early 1900s, preventing and treating influenza.

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The Legacy of the Pandemic
No one knows exactly how many people died during the 1918-1919 influenza pandemic. During the 1920s, researchers estimated that 21.5 million people died as a result of the 1918-1919 pandemic. More recent estimates have estimated global mortality from the 1918-1919 pandemic at anywhere between 30 and 50 million. An estimated 675,000 Americans were among the dead.
Research, forgetting the pandemic of 1918-1919, scientific milestones, 20th century influenza or global pandemics.

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shen said:

best disaster preparation!

That's my excuse too, and I'm sticking with it.

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bd popeye said:

The Ebola outbreak pales in comparison at this time to the Influenza pandemic of 1918-19. Were 21.5 million people died.

Please read.

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Livesscience -- The Ebola virus has now killed more than 4,000 people in West Africa. Although the mortality rate of the most recent outbreak isn't as high as in previous events, it's still the case that most people who become infected with Ebola will not survive. (The mortality rate is about 60 percent for the current outbreak, compared with 90 percent in the past, according to the National Institutes of Health.)
But despite this somber prognosis, health experts in the United States aren't particularly worried about the threat of Ebola in this country or in other developed countries.

"I see Ebola as a significant threat in the specific regions that it has been identified in, certainly central and west Africa," said Cecilia Rokusek, a public health expert with Nova Southeastern University's Institute for Disaster and Emergency Preparedness in Florida. "But in my opinion, it's not an imminent threat for those in the United States." [7 Devastating Infectious Diseases]

Indeed, other viruses pose a larger threat to U.S. citizens, according to Rokusek.

Although some of these viruses have far lower mortality rates than that of Ebola, they are more prevalent in developed nations, and kill more people annually than Ebola does. Here are five viruses that are just as dangerous (if not more so) than Ebola:

Rabies
Over the past 100 years, rabies has declined significantly as a public health threat in the United States, according to the Centers for Disease Control and Prevention. Approximately two people now die yearly in the United States from this virus, which is transmitted to people through saliva when they are bitten by infected animals, such as dogs or bats.

People who know they have been bitten by an animal should receive the rabies vaccine, which prevents infection by the virus, according to the CDC. But, especially in the case of bat bites, people may not always realize they have been bitten.

And rabies has one of the highest fatality rates of any virus; only three people in the United States are known to have ever survived the disease without receiving the vaccine after exposure to the virus.

Still, the disease remains a greater threat in other areas of the world than in the United States. Approximately 55,000 people die of rabies every year in Africa and Asia, according to the WHO.

HIV
Though the number of annual deaths related to human immunodeficiency virus (HIV) has declined in recent years, an estimated 1.6 million people worldwide died of HIV and acquired immune deficiency syndrome (AIDS) related causes in 2012, according to the WHO. The virus attacks a person's immune cells and weakens the immune system over time, making it very difficult for the infected individual to fight off other diseases.

About 15,500 people with an AIDS diagnosis died in 2010 in the United States, according to the CDC. In total, an estimated 650,000 people have died of AIDS in the United States since the disease was discovered in 1981. An estimated 36 million people have died worldwide from the epidemic.

Today, people with HIV do live longer than they used to, a trend that coincides with the increased availability of antiretroviral therapy, as well as the decline in new infections since the peak of the AIDS epidemic in 1997. However, no cure for HIV exists.

Influenza
The flu may not sound very scary, but it kills far more people every year than Ebola does. The exact number of people who die each year from seasonal flu virus is the subject of much debate, but the CDC puts the average number of annual deaths in the United States somewhere between 3,000 and 49,000.

The large variation in yearly deaths arises because many flu deaths are not reported as such, so the CDC relies on statistical methods to estimate the number. Another reason for this wide range is that annual flu seasons vary in severity and length, depending on what influenza viruses are most prominent. In years when influenza A (H3N2) viruses are prominent, death rates are typically more than double what they are in seasons when influenza A (H1N1) or influenza B viruses predominate, according to the CDC.

A highly contagious virus, influenza sickens far more people than it kills, with an estimated 3 million to 5 million people becoming seriously ill yearly from influenza viruses. Worldwide, the flu causes an estimated 250,000 to 500,000 deaths every year, according to the World Health Organization (WHO).

Despite the relatively low mortality rate of the virus, public health professionals and doctors recommend annual flu shots to keep the risk of complications from influenza at bay.

"Healthy people should get their vaccines every year," Rokusek told Live Science. "Studies have shown that the flu vaccine is an effective preventative measure."

But flu vaccines, which offer immunity from influenza A and B viruses, do not protect against other forms of influenza, which can arise when the virus undergoes genetic changes. New strains of the flu result in higher than average mortality rates globally. The most recent influenza pandemic, the "swine flu" or H1N1 pandemic, killed between 151,700 and 575,400 people globally during 2009 and 2010, according to the CDC.

Mosquito-borne viruses
Spread through the bite of an infected mosquito, viruses such as dengue, West Nile and yellow fever kill more than 50,000 people worldwide every year, according to estimates by the WHO and the CDC. (Malaria — which is also spread by mosquitos, but is caused by a parasite rather than a virus — kills more than 600,00 people yearly.)

At least 40 percent of the world's population, or about 2.5 billion people, are at risk of serious illness and death from mosquito-borne viral diseases, according to the CDC.

Dengue fever, which is endemic to parts of South America, Mexico, Africa and Asia, claims approximately 22,000 lives every year, according to the CDC. Dengue hemorrhagic fever is a deadly infection that causes high fevers and can lead to septic shock.

These diseases occur in regions neighboring the United States, making them a threat in this country.

"Dengue is very active in the Caribbean, and travelers to the Caribbean come back to the United States with dengue," said Dr. Robert Leggiadro, a New York physician and professor of biology at Villanova University in Pennsylvania. [10 Deadly Diseases That Hopped Across Species]

People infected with dengue while traveling abroad can spread the disease at home when mosquitos bite them, and then bite other people, Leggiadro said.

Even more deadly than dengue is yellow fever, which mostly affects people in Latin America and Africa. The disease causes an estimated 30,000 deaths worldwide, according to the WHO.

Less deadly, but still dangerous is West Nile virus, a viral neurological disease that is spread by mosquitos that bite humans after feasting on birds infected with the virus. Although the vast majority of people infected with this virus will not show symptoms of West Nile, the disease has killed an estimated 1,200 people in the United States since it was first seen here in 1999, according to the CDC.

Rotavirus
Not everyone is at high risk of contracting rotavirus, but for children around the world, this gastrointestinal virus is a very serious problem. Approximately 111 million cases of gastroenteritis caused by rotavirus are reported every year globally, according to the CDC. The vast majority of those affected by the virus are children under the age of 5, and about 82 percent of deaths associated with the virus occur in children in developing nations.

Globally, an estimated 440,000 children who contract the virus die each year from complications, namely dehydration. In the United States, a vaccine for rotavirus was developed in 1998, but was later recalled due to safety concerns. A newer vaccine, developed in 2006, is now available and is recommended for children ages 2 months and older.

Despite routine vaccinations for rotavirus in the United States, the CDC estimates that between 20 and 60 children under age 5 die every year from untreated dehydration caused by the virus.

While some parents in the United States have expressed concern about the complications that may arise as a result of vaccinating for rotavirus, Leggiadro told Live Science that vaccination for this and other preventable diseases is the best way to safeguard against diseases that, if left untreated, can be deadly.

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